The release of the Institute of Medicine (IOM) Future of Nursing report in October 2010 makes this an unprecedented time in healthcare and nursing IOM, 2010b). The political, economic, and social drivers of change include the focus on healthcare reform as well as the public demand for access to quality care and practice and care changes. There is also mounting evidence in respected reports about anticipated changes in nursing practice, education, recognition, and other aspects of the profession.
These forces have coalesced, opening a rare opportunity for the estimated 3 million registered nurses in the United States. There is a great incentive for nursing to act urgently, because this window will close as soon as the focus shifts to other pressing matters. Change is inevitable, healthcare is quickly evolving, and the ultimate outcome of the present healthcare reform is unknown. To prepare neuroscience nurses to lead change and advance health for all Americans, the American Association of Neuroscience Nurses (AANN) Board of Directors (BOD) passed a motion in July 2011 to adopt the following four key messages of the IOM Future of Nursing call to action and tie them to the AANN strategic plan.
IOM Future of Nursing Report: Four Key Messages
* Nurses should practice to the full extent of their education and training.
* Nurses should achieve higher levels of education and training through an improved educational system that promotes seamless academic progression.
* Nurses should be full partners with physicians and other healthcare professionals in redesigning U.S. healthcare.
* Effective workforce planning and policy making require better data collection and improved information infrastructure.
As the leading authority in neurosciences for nurses, the members of the BOD, who represent the AANN, recognized that they were one of the organizations that needed to take initiative on the future of nursing. The intent of this white paper is, therefore, to provide a blueprint for change by tying the four key messages of the IOM Future of Nursing report to the AANN strategic plan to assist nurses in initiating change in the neurosciences. Because of the changing roles and arenas in which neuroscience nurses practice, the scope of this article is, by design, broad and inclusive.
IOM Report: Key Message 1
The first key message of the IOM Future of Nursing report is that nurses should practice to the full extent of their education and training IOM, 2010b). Under this key message, there are two important subcategories; the first speaks about scope of practice, and the second pertains to nurse residency programs.
Subcategory 1: Scope of Practice
Neuroscience nurses must be able to practice to the full extent of their education and training regardless of whether they are working as a staff nurse at the bedside or as an advanced practice nurse in the community. For this reason, the AANN strategic plan called for and commenced a task force to update its 2002 Scope and Standards document. Precisely, there is a need to integrate the scope of practice for advanced practice registered nurses with those of bedside nurses to support excellence in the neurosciences, and the current revision will incorporate these needed changes.
* Support regular scope and standards updates.
* Collaborate with the American Nurses Association on the Scope and Standards document.
* Disseminate the revised Scope and Standards document to key stakeholders.
Subcategory 2: Transition-to-Practice (Nurse Residency) Programs
There is also a need to implement multilevel residency programs to manage entrance into neuroscience nursing (e.g., student to practitioner) and during transitions to positions of greater oversight (e.g., practitioner to coordinator, coordinator to director).
* Support transition-to-practice graduate nurse residency programs.
* Develop a competency-based transition-to-practice (nurse residency) program for entry into the subspecialty of neuroscience nursing.
* Support and facilitate the implementation of multilevel nurse residency programs across the continuum of care.
* Prepare an AANN position statement on competency-based transition-to-practice (nurse residency) programs for neuroscience.
* Disseminate the AANN position statement to key stakeholders.
IOM Report: Key Message 2
The second key message of the IOM Future of Nursing report is that nurses should achieve higher levels of education and training through an improved educational system that promotes seamless academic progression IOM, 2010b). As a continuing education provider, AANN is promoting the education of neuroscience nurses. It is also important that AANN considers supporting alternatives including degree and nondegree programs, fellowships, and institutes, which further the education and support lifelong learning of neuroscience nurses. The second key message fits well with two of the objectives in the AANN strategic plan. Objective 1 is to achieve industry-wide reputability as a producer of quality education products. Objective 2 is to explore the global market to provide education in neuroscience nursing.
* Foster a culture of lifelong learning (IOM, 2010a).
* Support the use of traditional educational methodologies (e.g., face-to-face, online, distance learning, simulation, etc.).
* Create entrepreneurial professional development education that enables neuroscience nurses to consider starting businesses intended to improve healthcare outcomes.
* Develop a comprehensive core of clinical performance competencies.
* Continue to identify research-based best practices and disseminate evidence of associated successes through AANN's Clinical Practice Guidelines.
* Disseminate innovative evidence-based care models.
* Continue to explore opportunities for AANN to introduce new products and services consistent with these recommendations.
IOM Report: Key Message 3
The third key message of the IOM Future of Nursing report calls for nurses to be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States (IOM, 2010b). Achieving this goal will require a shift in how nurses view their responsibilities to patients and relationships with other work team members, in addition to obtaining the educational preparation necessary to practice in this new healthcare model. The World Health Organization (2010) has also identified the need for healthcare professionals to learn to work collaboratively as members of a healthcare team as being essential for the delivery of effective healthcare. Neuroscience nurses, given the nature of patients' illness, routinely care for patients concurrently with interdisciplinary teams (e.g., physical therapy).
Advanced educational preparation and skill upgrades are necessary to practice in this healthcare model. Neuroscience nurses must possess a mix of skill sets that will enable them to perform as work team members, team leaders, and patient advocates. Elevating skill levels enhances confidence and provides the knowledge integral to being part of redesigning neuroscience healthcare.
Identified, however, is the shared perception that most nurses lack general and specific leadership competencies. For nurses to achieve this goal, development of leadership skills is a priority. Mastery of these core competencies is multifaceted too, because leadership skills (i.e., effective written and oral communication, delegation, etc.) are learned and honed over time. Nursing educators tasked with critically evaluating curricula must devise relevant methods for students to develop and utilize leadership skills during their program of study. The need for continued learning and self-development activities, which emphasize leadership skills, extends to practicing nurses as well. The question is how to best provide nurses with these activities and have them recognize their importance.
Nursing organizations such as the AANN have the opportunity to provide mentorship programs, leadership development, and leadership opportunities for all members. With its finger on the pulse of the neurosciences in nursing, AANN is a valued repository for those seeking expertise and opinions on neuroscience healthcare issues. To ensure success and renew vitality, the association should continue to provide leadership development and opportunities to lead for all members.
Members may access leadership development opportunities in AANN through a variety of venues. Constituent chapters are a primary networking vehicle for members to engage in organizational activities at the local level. Chapter presidents are members of a "Chapter Council," which is facilitated by a designated member of the national BOD. Chapter presidents may seek individual support, post questions to a designated List-Serve site, and participate in regularly scheduled conference calls with fellow chapter representatives and the BOD facilitator.
Members aspiring to be leaders may run for elected office (e.g., secretary/treasurer, director) or join a task force (e.g., local stroke awareness screening). Active participation in chapter activities may help members move progressively toward involvement on a national level. AANN members can answer the call for volunteers, for example, to serve on a committee (e.g., as a conference planner). Group process exposes members to an eclectic array of ideas, perspectives, and trends encouraging them to share feedback that shapes positive project outcomes.
As the expert resource in neuroscience nursing, AANN must remain at the forefront of the field by offering career development initiatives such as structured mentorship programs for neuroscience nurses. Mentorship in neuroscience nursing is essential to the growth and sustainability of the specialty. Formalized mentoring arrangements foster the transfer of leadership knowledge and skills through role modeling and role rehearsal, which is helpful to new initiates.
As healthcare becomes increasingly complex, an expectation of nursing is that the profession will provide its practitioners with a range of skills from the bedside to boardroom. Clearly, the need to possess effective leadership skills has never been more crucial. As such, several critical issues have prompted questions that merit further consideration.
* What preparation will provide nurses with the requisite leadership competencies necessary to function in the increasingly complex healthcare system?
* How can the fundamental concept of leadership be defined and contextualized so that it applies across the spectrum from bedside to boardroom?
* What is the meaning of the phrase "nurses as full partners," and how is the definition operationalized?
Providing answers to these questions will be a challenging and complex pursuit that requires "out-of-the-box" thinking and a collaborative approach.
* Create multilevel leadership programs that provide the skill sets needed for nurses to respond to changes in quality, access, and value of healthcare.
* Develop an AANN mentorship program with defined goals and organizational support to assist neuroscience nurses in mapping their professional growth and development and career trajectory.
* Explore the possibility of engaging in future joint endeavors with strategic partners.
* Solicit input from strategic partners (e.g., chief executive officers, government and corporate entities, healthcare systems, and professional societies) to design fellowship programs.
IOM Report: Key Message 4
The fourth key message of the IOM Future of Nursing report is for effective planning and policy making, which requires better data collection and improved information infrastructure. Under this fourth key message, there are two important subcategories; the first speaks of effective planning, and the second pertains to policy making.
Subcategory 1: Effective Planning
To transform the U.S. healthcare delivery effectively, current and future data regarding the healthcare workforce must be accurate as well as collected and analyzed. Having these capacity data will allow for the development of workforce model projections that will be instrumental for the transformation of nursing practice and education (IOM, 2010b, p. 256).
* Invest in information systems and technology.
* Conduct thoughtful data collection and data mining for data-driven decision making.
* Develop partnerships and coalitions at the national level to more effectively plan for the subspecialty of neuroscience nursing.
* Engage the membership in the planning and implementation processes.
* Review and update the organizational strategic plan in light of landmark reports.
* Engage in discussions with a variety of stakeholders regarding effective planning.
Subcategory 2: Policy Making
President Barack Obama signed into law the Patient Protection and Affordable Care Act (2010) on March 23, 2010. This law is the principal part of healthcare reform of the private and public health insurance programs. It increases insurance coverage for preexisting conditions and aims to expand access to insurance for more than 3 million Americans.
According to an April 2010 memorandum from the Centers for Medicare and Medicaid Services, the estimated impact of the Patient Protection and Affordable Care Act on the total national health expenditures in the United States during 2010-2019 is an approximate increase of 0.9%. Moreover, "the additional demand for health services could be difficult to meet initially with existing health provider resources and could lead to price increases, cost-shifting, and/or changes in providers' willingness to treat patients with low-reimbursement health coverage" (p. 21, http://www.cms.gov/ActuarialStudies/downloads/PPACA_2010-04-22.pfd). The strategic plan for AANN has identified the goal to "influence the advancement of the field of neurosciences." The BOD recognizes the need to engage in discussions with multiple stakeholders to monitor health policy issues and the need to align with other organizations to obtain the necessary data needed during this pivotal time.
* Establish relationships with mission-similar organizations and identify the primary purpose of these relationships.
* Establish the organizational role in advocacy.
* Recognize and prioritize needs and engage in select political actions.
* Understand how health policy and related changes affect the organization (governances and membership).
* Create a strategic communications plan to influence decision makers.
* Develop partnerships and coalitions at the national level to gain influence for the subspecialty of neuroscience nursing.
* Monitor healthcare policies and issues related to healthcare reform.
* Assess the actual or potential transformative effect of policies on neuroscience nursing practice and the organization overall.
In response to the IOM Future of Nursing report, the AANN BOD initiated a blueprint for strategic change at the meeting of July 2010. During this time, the BOD approved the AANN Advocacy Statement, appointed a standing advocacy committee, and approved the criteria for prioritizing policy and advocacy opportunities from the American Stroke Association and the American Heart Association to be the AANN criteria. The charge to the advocacy committee is to develop policies, procedures, and criteria for the organizational role in advocacy.
The development of this formal process is a precursor to establishing partnerships and coalitions at the national level. It will generate opportunities for our organization and members to invest in information systems and technology for data collection and data mining. This, in turn, will permit effective workforce planning for the neuroscience population. In addition, increased partnerships will improve our ability to monitor the impact on health policy at the BOD and membership levels to influence decision makers. AANN is proud of its current alliances and partnerships, which include the following:
* Affiliate Member of the American Nurses Association,
* American Heart Association/American Stroke Association,
* Canadian Association of Neuroscience Nurses,
* European Association for Neuroscience Nurses,
* Neuroscience Nurses Foundation,
* World Federation of Neuroscience Nurses, and
* World Parkinson Association.
As the leading authority in the neurosciences for nurses, the directors recognized that AANN was one of the professional organizations that needed to take initiative on the future of nursing. This white paper provides a blueprint for change by tying the four key messages in the IOM Future of Nursing report to the organizational strategic plan informing nurses about the need to initiate change in the neurosciences. Because of the changing roles and arenas in which neuroscience nurses practice, the scope of this article is, by design, broad and inclusive. In the end, it is up to each of us to carry this forward and initiate change in the neurosciences.
The authors would like to acknowledge that the writing of this paper was a dynamic team effort. In particular we thank our wonderful AANN Liaison (Linda Littlejohns, RN, MSN, CCRN, CNRN, FAAN) as well as our fantastic reviewers (Elaine M. Kopp, BSN, RN; Abby Lotz, BSN, RN, CNRN; and Donna Avanecean, RN, MSN, FNP-C, CNRN).